About Circumcision Rates Too Low

"There's a good case to be made that circumcisions can protect our children," said study author Arleen A. Leibowitz, a professor of public policy at the University of California, Los Angeles. "If you can alleviate the cost of the procedure, then people are more likely to adopt it."

Circumcision rates have been dropping since the 1980s amid controversy about whether the procedure is necessary or desirable. More states, meanwhile, have stopped paying for the procedure through Medicaid, including 10 in this decade alone. If all states covered circumcision, the percentage of male babies who get the procedure would rise from 56 percent to 62 percent, Leibowitz estimated.

Critics say circumcision is brutal and robs males of sexual sensation, but many in the medical community point to research that suggests circumcision reduces the risk of sexually transmitted diseases such as AIDS and the virus that can cause cervical cancer.

Currently, 16 states don't cover circumcision through their Medicaid programs, according to the new study. The procedure for an infant can cost $250 to $300, Leibowitz said.

Circumcision rates among Latinos are especially low, even if the government pays for the procedure, Leibowitz said. She added that rates are about equal among whites and blacks.

The study authors looked at a national sample of 417,282 newborn boys from 2004. The researchers examined the statistics with an eye toward whether the states where the boys were born covered circumcision.

The findings were published in the January issue of the American Journal of Public Health.

According to Leibowitz, the states that don't cover the procedure are: Arizona, California, Florida, Idaho, Louisiana, Maine, Minnesota, Mississippi, Missouri, Montana, Nevada, North Carolina, North Dakota, Oregon, Utah and Washington.

The researchers adjusted the numbers to account for factors such as the number of days that infants spent in the hospital. According to Leibowitz, it's difficult to fit in a circumcision if the baby is just there for a day.

Even with the adjustments, circumcision rates were significantly lower in states that didn't pay for the procedure through Medicaid, she said, adding that "not covering it under Medicaid sends a signal to recipients that this not a valuable procedure."

Robert C. Bailey, a professor of epidemiology at the University of Illinois at Chicago, said the poor are robbed of a chance to make a choice about circumcision because of the lack of funding.

"It's another way in which our health system is increasing inequality across the population," he said. "People who can't afford good health care are essentially being discriminated against by this policy."

SOURCES: Arleen A. Leibowitz, Ph.D., professor, public policy, University of California, Los Angeles; Robert C. Bailey, Ph.D., professor, epidemiology, University of Illinois at Chicago; January 2009, American Journal of Public Health.

Info about CDC Warns of Drug-Resistant Flu Bug

Flu is a dangerous and sometimes deadly disease. But the Tamiflu-resistant strain isn't any more or less dangerous than other flu strains.

The Tamiflu-resistant virus is the flu bug most commonly seen so far this year. It's been detected in 12 states so far, mostly in Hawaii and Texas.

Tamiflu resistance wasn't unexpected. What was surprising was the rapid rise of Tamiflu resistance in this particular flu bug. Last year, about 11% of type A H1N1 flu bugs were resistant. So far this year, 49 out of 50 H1N1 viruses have been resistant.

Even so, it's still very early in the flu season. There's no way to know whether the Tamiflu-resistant flu bug will be this year's predominant cause of flu.

"There is no crystal ball here," CDC Director Julie Gerberding, MD, tells WebMD. "We can't predict if this strain will end up being the most important one this year. It could fizzle out. ... We're giving a 'heads-up' to the clinicians, but we are not making drastic changes in our treatment and prevention recommendations."

Three different flu bugs are in circulation among humans. The resistant bug is the type A H1N1 strain. There's also the type A H3N2 strain, and one type B strain.

The current flu vaccine protects against all three of these viruses -- and the current flu vaccine is an excellent match for the drug-resistant bug, Gerberding says.

Fortunately, the Tamiflu-resistant flu bug is still sensitive to Relenza, an alternative flu drug of the same basic type as Tamiflu. And the bug may also be sensitive to the older flu drugs Flumadine and Symmetrel, although resistance to these drugs has been steadily increasing among type A flu bugs.

Flu drugs can be used both to treat and to prevent the flu:

• Treatment with flu drugs must begin no later than two days after symptoms appear. The earlier that treatment begins, the shorter and less severe the illness.
• Prevention with flu drugs is used in households, hospitals, or facilities (such as nursing homes) where people have been exposed to someone who has the flu.

Tamiflu has been the most attractive treatment because it is taken in pill form and can be given to children as young as 1 year old.

Relenza comes in an inhaler. Children younger than 7 can't use it for treatment, and those younger than 5 can't use it for prevention. Moreover, Relenza sometimes causes lung spasms, so it can't be used by people with lung problems.

Ironically, the CDC's Tamiflu warning is not going to make a huge difference in how patients are treated because too few people get treated with flu drugs, says Joseph S. Bresee, MD, chief of the epidemiology and prevention branch of the CDC's flu division.

"Even among hospital patients with the flu, more than half do not receive antiviral therapy," Bresee tells WebMD. "[Tamiflu] and [Relenza] are relatively underused at this point."

Bresee suggests that the current warning might actually increase use of flu drugs by making doctors more aware of how to use them.

Here's what the CDC now recommends:

• Doctors should keep track of the subtypes of flu virus circulating in their areas. The CDC offers weekly updates based on reports from local and state health agencies.
• When testing patients for the flu, doctors should consider using tests that can tell type A flu from type B flu.
• Use Tamiflu alone only if the main flu bugs in the area are type A H3N2 or type B.
• If drug-resistant virus is circulating in the area, use Relenza. In patients unable to take Relenza, doctors may use a combination of Tamiflu and Flumadine (or Symmetrel if Flumadine isn't available).

But here's the best advice: It's not too late to get a flu shot (or sniff, via the inhaled FluMist vaccine). Flu season rarely peaks before February -- and lots of people come down with the flu as late as March or April. So if you've been putting off getting your flu shot, now is the time to act.

SOURCES: CDC Health Advisory, Dec. 19, 2008. Julie Gerberding, MD, MPH, director, CDC. Timothy M. Uyeki, MD, medical epidemiologist, influenza branch, CDC. Joseph S. Bresee, MD, chief of epidemiology and prevention, influenza branch, CDC.

Info Even a Little Overweight, Inactivity Hurts the Heart

Even a few extra pounds and just a little inactivity increased the risk of heart failure in a major study of American doctors.

"What this study shows is that even overweight men who are not obese have an increase in heart failure risk," said Dr. Satish Kenchaiah, lead author of a report on the finding in the Dec. 23 issue of Circulation.

As for exercise, "even a little amount of physical activity appears to decrease the risk of heart failure," said Kenchaiah, who did the research as a epidemiologist at Brigham and Women's Hospital in Boston and is now at the U.S. National Heart, Lung, and Blood Institute.

The study has followed more than 21,000 doctors for two decades, measuring among other factors the influence of overweight and physical activity on development of heart failure, the progressive loss of ability to pump blood, which is often a prelude to major coronary events.

Outright obesity, defined as a body-mass index of 30 or over, has long been known as a risk factor for heart failure. The new report concentrated on men who were borderline overweight, with a body-mass index of 25 to 29.9.

About 5 percent of the doctors were obese, and 40 percent were overweight, when the study began. Adjusting for other risk factors such as high blood pressure and high cholesterol, the study found a 49 percent increased incidence of heart failure in overweight men compared to those with a body-mass index of 25 or less. Incidence of heart failure was 180 percent for the obese men compared to the leaner ones.

It was the same story for physical activity. "Men who engaged in physical activity anywhere from one to three times a month had an 18 percent reduction in heart failure risk," Kenchaiah said. "For those who were active five to seven times a week, the reduction was 36 percent. The more you exercise, the more reduction you achieve."

The association of even minimal physical activity with reduced risk could be explained as an indicator of good habits in general, he said. "It is possible that they have a healthier lifestyle in general," Kenchaiah said.

The study found that doctors who rarely or never exercised were older, smoked cigarettes more often, and were more likely to have high blood pressure or diabetes.

"This new report reinforces what we've said in the past," said Dr. Gerald Fletcher, a preventive cardiologist at the Mayo Clinic in Jacksonville, Fla. "Not being obese but being overweight is definitely a risk factor for heart failure."

While Fletcher said he would have liked a more definitive indicator of physical activity -- the report described it as simply breaking a sweat -- he said the study showed again that "vigorous exercise makes the difference. The more you do, the better it is for you."

Two-thirds of Americans have excess body weight, and only about 30 percent exercise regularly, Kenchaiah said from medicinenet.com. About 660,000 new cases of heart failure are diagnosed each year in the United States, he said, and 80 percent of the men and 75 percent of the women aged 65 and older who are diagnosed with heart failure die within eight years.

SOURCES: Satish Kenchaiah, M.D., U.S. National Heart, Lung, and Blood Institute, Bethesda, Md.; Gerald Fletcher, M.D., preventive cardiologist, Mayo Clinic, Jacksonville, Fla.; Dec. 23, 2008, Circulation

Copyright © 2008 ScoutNews, LLC. All rights reserved.

Info Phenols in Quality Olive Oil Suppress Breast Cancer Gene

Extra-virgin olive oil, which is produced by pressing olives without the use of heat or chemical treatments, contains phytochemicals that are otherwise lost in the refining process. The Spanish researchers separated extra-virgin olive oil into fractions and tested these against breast cancer cells in the lab. They found that all the fractions that contained major extra-virgin phytochemical polyphenols (lignans and secoiridoids) effectively inhibited the breast cancer gene HER2.

The study was published in current issue of BMC Cancer.

Spanish researchers have identified anti-cancer chemicals in extra-virgin olive oil that may help explain the apparent link between eating an olive oil-rich Mediterranean diet and a reduced risk of breast cancer.

Our findings reveal for the first time that all major complex phenols present in extra-virgin olive oil drastically suppress overexpression of the cancer gene HER2 in human breast cancer cells," Javier Menendez, of the Catalan Institute of Oncology, said in a BioMed Central news release.

While the study results offer new insights into how extra-virgin olive oil may help reduce HER2 breast cancer risk, the findings must be viewed with caution.

"The active phytochemicals [i.e. lignans and secoiridoids] exhibited tumoricidal effects against cultured breast cancer cells at concentrations that are unlikely to be achieved in real life by consuming olive oil," the researchers noted.

However, they also said their findings, "together with the fact that humans have safely been ingesting significant amounts of lignans and secoiridoids as long as they have been consuming olives and extra-virgin oil, strongly suggest that these polyphenols might provide an excellent and safe platform for the design of new anti-breast cancer drugs."

-- Robert Preidt

SOURCE: BioMed Central, news release, Dec. 17, 2008

Info Hot Fitness Trends for 2009

Today i read article from medicinenet.com The group is out with its top 10 fitness trends for the upcoming year, after surveying personal trainers, group fitness professionals, and lifestyle and weight management consultants.

For the second year in a row, boot camp-style workouts are predicted to be the top fitness trend for 2009. Boot camps, group classes that aim to strengthen large muscle groups with pushups, squats, and lunges, can burn up to 600 calories during one session.

Another trend? Getting more for the money, says ACE Chief Science Officer Cedric X. Bryant, PhD, in a news release. "The overarching theme for fitness in 2009 is getting more bang for the buck."

Bryant says, "Consumers will engage in workouts that provide multiple benefits due to time and economic limitations. We will also see continued trends from 2008 including boot-camp style workouts, technology-based workouts, out-of-the-box programming, and an increased interest in fitness for those who are over 50 years old."

Here's the ACE's top trend rundown:

1. Boot camp-style fitness programs.
2. Workout plans that are less expensive.
3. Specialty classes like Zumba, Bollywood, Afro-Cuban, and ballroom dancing. These classes are set to rhythmic music and aim to increase cardiovascular fitness while folks have fun.
4. The basics. Fitness professionals believe that people will want to return to basic fitness programs.
5. Circuit training. Circuit training blends strength training and cardiovascular activity at different intensities. Another plus: gyms can set up their own circuit for members to follow.
6. Kettlebell training. These iron weights, traditionally used in Russia, aim to develop whole body fitness and core strength.
7. Boomer fitness. A focus on fitness led by people 50 and older.
8. Technology-based fitness. Using high-tech gadgets like iPods to help keep workouts engaging, plus an increase in interactive fitness video games.
9. Event or sports-specific exercises. A focus on the simple things, like basketball or volleyball games, or day bike rides.
10. Mixing it up. Low-intensity cardio or weight training on one day, followed by a high-intensity workout on another day.

SOURCES: News release, American Council on Exercise.

Info about Diabetic Eye Disease Rates Soaring

Diabetic retinopathy, which is damage to the small blood vessels in the retina, is the leading cause of blindness among working-age adults in the United States. In 2004, about $500 million was spent on direct medical costs for diabetic retinopathy, according to background information in the study.

The number of Americans with diabetic retinopathy is expected to increase from 5.5 million to 16 million by the year 2050, according to a U.S. Centers for Disease Control and Prevention study.

"People with diabetes mellitus also have a higher prevalence of other eye diseases, such as cataracts and glaucoma, than the general population," the researchers wrote. medicinenet.com "Vision loss related to eye disease among people with diabetes is an important disability that threatens independence and can lead to depression, reduced mobility and reduced quality of life."

For their study, Dr. Jinan B Saaddine and colleagues analyzed data from the 2004 National Health Interview Survey and the U.S. Census Bureau to predict the number of Americans with diabetes who will have diabetic retinopathy, vision threatening diabetic retinopathy, glaucoma and cataracts in 2050, when the country's population is expected to be 402 million.

Along with the increase in diabetic retinopathy cases from 5.5 million to 16 million, the researchers also projected that:

• The number of cases of vision threatening diabetic retinopathy will increase from 1.2 million to 3.4 million.
• Among Americans 65 and older, the number of cases of diabetic retinopathy will rise from 2.5 million to 9.9 million, and the number of cases of vision threatening diabetic retinopathy will increase from 500,000 to 1.9 million.
• Cataract cases among whites and blacks age 40 or older with diabetes will increase 235%.
• Cataract cases among people age 75 and older with diabetes will increase 637% for black women and 677% for black men.
• Glaucoma cases among Hispanics age 65 and older with diabetes will increase 12-fold.

"In summary, our projections have shown higher numbers than previously estimated for diabetic retinopathy, vision threatening diabetic retinopathy, cataracts, and glaucoma among Americans with diabetes. Efforts to prevent diabetes and to optimally manage diabetes and its complications are needed," the researchers concluded.

The study was published in the December issue of the journal Archives of Ophthalmology.

-- Robert Preidt

SOURCE: JAMA/Archives journals, news release, Dec. 8, 2008

Info Too Little Vitamin D Puts Heart at Risk

New Info Getting too little vitamin D may be an underappreciated heart disease risk factor that's actually easy to fix.

Researchers say a growing body of evidence suggests that vitamin D deficiency increases the risk of heart disease and is linked to other, well-known heart disease risk factors such as high blood pressure, obesity, and diabetes.

For example, several large studies have shown that people with low vitamin D levels were twice as likely to have a heart attack, stroke, or other heart-related event during follow-up, compared with those with higher vitamin D levels.

"Vitamin D deficiency is an unrecognized, emerging cardiovascular risk factor, which should be screened for and treated," says researcher James H. O'Keefe, MD, director of preventive cardiology at the Mid America Heart Institute in Kansas City, Mo., in a news release. "Vitamin D is easy to assess, and supplementation is simple, safe and inexpensive."

Most of the body's vitamin D requirements are met by the skin in response to sun exposure. Other less potent sources of vitamin D include foods such as salmon, sardines, cod liver oil, and vitamin D-fortified foods like milk and some cereals. Vitamin D can also be obtained through supplements.

Vitamin D Deficiency on the Rise

Vitamin D deficiency is traditionally associated with bone and muscle weakness, but in recent years a number of studies have shown that low levels of the vitamin may predispose the body to high blood pressure, congestive heart failure, and chronic blood vessel inflammation (associated with hardening of the arteries). It also alters hormone levels to increase insulin resistance, which raises the risk of diabetes.

In a review article published in the Journal of the American College of Cardiology, researchers surveyed recent studies on the link between vitamin D deficiency and heart disease to come up with practical advice on screening and treatment.

They concluded that vitamin D deficiency is much more common than previously thought, affecting up to half of adults and apparently healthy children in the U.S.

Researchers say higher rates of vitamin D deficiency may be due in part to people spending more time indoors and efforts to minimize sun exposure through the use of sunscreens. Sunscreen with a sun protection factor (SPF) of 15 blocks approximately 99% of vitamin D synthesis by the skin.

"We are outside less than we used to be, and older adults and people who are overweight or obese are less efficient at making vitamin D in response to sunlight," says O'Keefe. "A little bit of sunshine is a good thing, but the use of sunscreen to guard against skin cancer is important if you plan to be outside for more than 15 to 30 minutes of intense sunlight exposure."

Testing for Vitamin D Deficiency

Vitamin D levels can be measured with a blood test that looks at a specific form of vitamin D called 25-hydroxy vitamin D (25(OH)D). Vitamin D deficiency is defined as a blood 25(OH)D level below 20 ng/dL. Normal levels are considered to be above 30 ng/dL.

Researchers recommend 25(OH)D screening for those with known risk factors for vitamin D deficiency including:

• Older age
• Darkly pigmented skin
• Reduced sun exposure due to seasonal variation or living far from the equator
• Smoking
• Obesity
• Kidney or liver disease

The U.S. government's current recommended daily allowance (RDA) for vitamin D is 200 international units (IU) per day for individuals under age 50. For those between 50 and 70, 400 IU per day is recommended, and for those over age 70, the RDA is 600 IU. Most experts believe these doses are too low, and that somewhere between 1,000 and 2,000 IU of vitamin D per day is necessary to maintain adequate vitamin D levels. The safe upper limit of vitamin D consumption is 10,000 IU per day.

Vitamin D supplements are available in two different forms: Vitamin D2 and Vitamin D3. Although both appear effective in raising vitamin D blood levels, Vitamin D3 supplements appear to result in a longer-lasting boost.

Although there are no current guidelines for restoring and maintaining healthy vitamin D levels in people at risk for heart disease, for those who are vitamin D deficient, the researchers recommend initial treatment with 50,000 IU of vitamin D2or D3 once a week for eight to 12 weeks, followed by maintenance with one of the following strategies:

• 50,000 IU vitamin D2or D3 every 2 weeks
• 1,000 to 2,000 IU vitamin D3 daily
• Sunlight exposure for 10 minutes for white patients (longer for people with increased skin pigmentation) between the hours of 10 a.m. and 3 p.m.

Once maintenance therapy has been initiated, rechecking 25(OH)D blood levels is recommended after three to six months of ongoing supplementation.

"Restoring vitamin D levels to normal is important in maintaining good musculoskeletal health, and it may also improve heart health and prognosis," says O'Keefe. "We need large, randomized, controlled trials to determine whether or not vitamin D supplementation can actually reduce future heart disease and deaths." from medicinenet.com

SOURCES: Lee, J. Journal of the American College of Cardiology, Dec. 9, 2008; vol 52: pp 1949-1956. News release, American College of Cardiology.

Info about Soft Plastic Toys Are Health Risk

A consumer watchdog group is urging parents to avoid buying soft plastic toys this holiday season because of a risk that the toys may contain toxic chemicals.

Toys containing the chemicals, called phthalates, can no longer be manufactured or imported after February 2009, according to a product safety law that passed Congress over the summer.

But the group says the Consumer Product Safety Commission is allowing the toy industry to circumvent the law. The agency wrote a letter last week telling manufacturers they can still sell their existing stocks of phthalate-containing toys even after the ban takes effect in February.

"They're giving the industry a loophole," says Liz Hitchcock, a public health advocate for the U.S. Public Interest Research Group (U.S. PIRG).

Phthalates are a group of chemicals used to soften vinyl and other plastics. Congress banned use of the chemicals in toys because of evidence they can have health effects including early puberty, reproductive defects, and lower sperm counts in boys.

U.S. PIRG offered the following tips for avoiding unsafe toys:

• Don't buy soft toys made of "PVC" (polyvinyl chloride) plastic. Many of these contain phthalates and may not be labeled.
• Avoid play cosmetics with xylene or toluene or phthalates.
• Avoid cheap metal play jewelry, key chains, and similar products. Many of these products contain lead.
• Avoid toys with small parts that can pose a choking hazard to young children. Bring along a toilet paper tube on your shopping trip. Any toys or parts that fit inside the tube are too small for children aged 3 and under.

The new law stands to increase the budget and personnel at the Consumer Product Safety Commission and give the agency tougher recall authority.

The agency's move on phthalates sparked angry reactions from several Democratic members of Congress, who accused the Bush Administration of avoiding the intent of the new law.

Julie Vallese, a Consumer Products Safety Commission spokeswoman, says that the agency was not trying to give toy makers a way out of meeting new rules on phthalates. She said the wording of the law sets new standards for phthalates but does not automatically ban their sale in toys.

"Where U.S. PIRG's criticism should be is on Congress. If they don't like the language that they used, Congress has the authority to fix it," Vallese tells WebMD.

Joan Lawrence, vice president for safety standards and regulatory affairs for the Toy Industry Association, defends the industry's safety record. "The industry has been massively inspecting and testing toys since last year and government has too," she says. "The fact is, there are just far fewer issues. There's strong science that says phthalates are safe as used in toys."

Lawrence is critical of advice to avoid purchasing soft plastic toys. "I don't know that that's helpful for parents," she says. "Many soft toys don't contain pthalates, so parents will be avoiding a lot of toys for no reason." medicinenet.com

SOURCES: Trouble in Toyland, the 23rd Annual Survey of Toy Safety, U.S. Public Interest Research Group. Nov. 25, 2008. Liz Hitchcock, public health advocate, U.S. PIRG. Sen. Barbara Boxer, D-Calif., letter to CPSC general counsel, Nov. 21, 2008. Julie Vallese, spokeswoman, Consumer Product Safety Commission. Joan Lawrence, vice president for safety standards and regulatory affairs, Toy Industry Association.